There are times when retired Staff Sgt. Matt Lammers doesn't look like he needs anyone's help — like when he was competing, and winning, races at the Department of Defense Warrior Games in Tampa, Fla., this summer.
"We don't like to say the word 'can't' in our family," says Matt, who lost both his legs above the knee and his left arm to an explosion during his second deployment to Iraq in 2007.
Then he goes on to list all the things he just can't do without help from his wife, Alicia.
"She helps me shower. ... She helps me transfer in my wheelchair, drives me to my appointments," says Matt, while on a break between events at the games. "I'd honestly say, not to be smart, but the question is, What she doesn't do?"
Matt won medals at the games in Tampa for sitting volleyball, swimming and indoor rowing. At the end of the games, the U.S. Army gave him the "heart of the team" award. But he and his wife almost didn't attend, because they were short on cash to make the trip after Alicia was cut from the Department of Veterans Affairs' caregiver program last December because Matt had not "consistently engaged in treatment," according to a letter from the VA. Alicia had been Matt's official caregiver for most of eight years.
"It felt like a stab in the back, like what I do is not worth it in their opinion, like I'm not part of their team like I thought I was," she says.
Uneven standards and implementation
The VA program provides support and a stipend to caregivers for post-Sept. 11 veterans, usually a wife or parent. It got going in 2011 and was instantly popular among vets as recognition of the billions of dollars worth of labor performed by family members for disabled veterans through the decades. The program was prepared for only a small number of applications and was overwhelmed by the tens of thousands of veterans who applied.
Almost from the start, that meant problems with uneven standards and implementation around the United States. NPR has reported on hundreds of caregivers being arbitrarily cut from the program; so has the Government Accountability Office and the VA's inspector general. Twice in two years, the VA has frozen the process of discharging people from the caregiver program, most recently last Dec. 20.
"It is essential that we get this right," VA Secretary Robert Wilkie said at the time. "This affects one of our most vulnerable veteran populations, and we need to make sure we have consistency on how we process and evaluate benefit applications across VA."
Unfortunately for Matt and Alicia, that freeze came six days after a letter from the VA in Fayetteville, N.C., on Dec. 14.
"I got a letter saying that I was out of the program because the veteran hasn't shown any progress since 2011," said Alicia. "I asked them, 'What do you mean by progress?' "
That question is at the heart of a fundamental problem with the way the VA caregiver program was created. Originally it was intended as a temporary intervention.
"Well, amputations and paralysis are permanent conditions," says Sherman Gillums, a former Marine who is paraplegic. "It's not about recovery. It's about sustaining your life. Even if they're cut off from the program, they're still needing that care."
Gillums is with the group AMVETS, but he's also on the VA's caregiver advisory committee. He's concerned that the VA needs to change the "recovery based" model now, before a planned expansion to older vets that could double or even triple the number of caregivers enrolled. And he says the program should be permanent for catastrophically injured vets such as Matt.
"No significant improvement"
Not that Matt's case is without its complications. Besides his missing limbs, Matt has PTSD and brain injuries.
"Not just the physical but the mental disabilities too — that is very challenging. It's every day. It's a constant change," says Alicia.
She says that's why the VA's assessment that Matt hasn't improved hurt. He's doing better now than he has in years. He has struggled in the past with drug abuse and even ended up homeless. He has been abusive to his wife and others, sometimes physically.
"He has progress daily," says Alicia. "But sometimes he has bad days or weeks. ... Life is like that."
The Fayetteville VA told the couple in the Dec. 14 letter that "there has been no significant improvement" since Matt entered the program in 2011 and that he "has not consistently engaged in treatment."
In response to a query from NPR, the Fayetteville VA said that for Matt, the program "was no longer in his best interest. He refused to follow his care plan, seriously endangering his health and that of those around him."
The VA was alluding to his abusive behavior in the past. But Alicia says she has stuck with him through that.
"I'm not leaving. I'm still with him, and I'm still gonna do what I do," she says. "I still have to help him. I still have to drive him. I still have to take him to appointments. I'm still gonna do this if you pay me or not."
The VA also reached out to the couple and encouraged them to follow the VA's care plan and then reapply for the caregiver program in six months. They say they will, but Matt says he's still stung by the assessment that he hasn't made progress since 2011.
"All three of my limbs are still amputated, as they were June, 10 June 2007. Those have not grown back," says Matt. "I wouldn't change anything for the world. I'm not complaining. I don't get hung up on injuries, but what they exactly expect from us triple amputees, single amputees, paras ... I don't, I can't really comprehend that."
RACHEL MARTIN, HOST:
When wounded troops come home from the battlefield, they often need full-time care. And more often than not, that comes from a family member. The VA has been giving these caregivers a stipend to help offset the costs for families. But now some vets are getting kicked off the program, vets like Matt Lammers, who lost both his legs and an arm in the Iraq War back in 2007. Recently the government decided that he and his wife no longer qualify for support, in part because of Matt's behavior. As NPR's Quil Lawrence reports, their story brings up questions like which veterans deserve support and how long should they get it?
QUIL LAWRENCE, BYLINE: At times, Matt Lammers looks like he doesn't need anyone's help.
UNIDENTIFIED ANNOUNCER: In the No. 1 position, Matt Lammers, from the Army.
LAWRENCE: This summer at the Pentagon's Warrior Games in Tampa, Lammers competed in sitting volleyball, swimming and indoor rowing.
UNIDENTIFIED ANNOUNCER: The results of round one.
LAWRENCE: He rigged a brace to hold down the stumps of his legs while he hauls with his one remaining arm, flinging his whole torso backward against the rowing machine.
UNIDENTIFIED ANNOUNCER: Final results.
LAWRENCE: He won his race, and at the end of the games, the U.S. Army gave him the Heart of the Team Award. It's a title you could also give to Matt's wife, Alicia, who he says did what it took to get him here.
MATT LAMMERS: I'd honestly say - not to be smart, but - the question's more, what doesn't she do? Because she does so much.
LAWRENCE: Back at their hotel room, Matt Lammers makes a list.
M LAMMERS: She helps me shower, in all honesty. Clipping my nails. That's a huge one. I - we don't like saying the word can't in our family. However, that's something that I really can't do with one arm. She helps me transfer my wheelchair, drives me to my appointments.
ALICIA LAMMERS: It's a way to support each other. His goals became my goals.
LAWRENCE: Alicia Lammers has been her husband's caregiver for much of the past eight years with a stipend from the VA. And Matt can be difficult. He's tough to take care of.
A LAMMERS: Not just the physical disability. We're talking about the mental disabilities, too, that is very challenging. It's an everyday - it's a constant change.
M LAMMERS: Reminding me of why we're still in the fight, why we still go on. Why we never give up. She does a lot. Without her, I don't know where I'd be at this point, just after all of my mistakes in the past.
LAWRENCE: And he has made mistakes. He's had trouble with drugs. He's abused his wife and others, sometimes physically. He's mistreated VA staff. He's no poster child, except maybe for survival, and for how much worse it could be without the help of a spouse willing to make taking care of him a full-time mission. Caregivers say the VA program validates their sacrifice. That's why it was so devastating last December when VA kicked Alicia off the program. In a letter, the VA in Fayetteville, N.C., said Matt had made no significant improvements since 2011 and hadn't consistently engaged in treatment.
A LAMMERS: I feel, like, a stab in the back - like what I do is not worth it in their opinion, like I'm not part of their team like I thought I was.
LAWRENCE: They're not alone in their frustration. The caregiver program has been overwhelmed by applications from its creation in 2011. It's been administered inconsistently with some VAs purging huge numbers from their rolls. Media coverage by NPR and others has driven the VA to freeze all removals twice in the past two years, most recently, in December, after Senator Patty Murray pressed VA Secretary Robert Wilkie at a hearing.
(SOUNDBITE OF ARCHIVED RECORDING)
PATTY MURRAY: We're hearing that this is a continuing problem in the VA's management of this program.
ROBERT WILKIE: I am going to do everything I can to make sure everybody stays in the program. It's that important to me, personally.
LAWRENCE: Following that hearing, Secretary Wilkie halted all removals from the program. That was December 20, six days too late for Matt and Alicia Lammers. They had just moved from Arizona to near Fayetteville. A letter from the Fayetteville VA dated December 14 kicked them off the program. Fayetteville also denied their appeal in the spring and then rejected Alicia's brand-new application on June 28. Her response...
A LAMMERS: I'm not leaving. I'm still with him, and I'm still going to do what I do.
LAWRENCE: The Fayetteville VA told NPR that the program was, quote, "no longer in his best interest. He refused to follow his care plan, seriously endangering his health and that of those around him." The bottom line appears to be Matt Lammers' past abusive behavior. That's what drove the Fayetteville VA to drop his wife, Alicia, from the program. The Lammers' case, says Sherman Gillums with the group AMVETS, highlights a faulty assumption from the start of the caregiver program.
SHERMAN GILLUMS: That VA would argue sometimes it was never meant to be a permanent program. Well, amputations and paralysis are permanent conditions.
LAWRENCE: Gillums is a former Marine who's paraplegic. He's on the VA's advisory board for the caregiver program. He says it was created as a short-term, recovery-based intervention, and that's not the reality for some vets.
GILLUMS: It's not about recovery. It's about sustaining your life. That person is going to be a part of the caregiving function for that individual for the rest of his or her life in some way, shape or form. Even if they're cut off from the program, they're still needing that care.
LAWRENCE: Gillums says the program needs to accept the reality that catastrophically injured vets may always need help.
GILLUMS: So when you hear about a triple amputee who's not going to the hospital or keeping appointments, and that's the standard by which you judge whether caregiver support will be given, I think it's wrong.
LAWRENCE: VA told NPR it understands that some program participants may always need a caregiver, but even those veterans need to stick with their treatment plan. For now, VA has reached out and encouraged Matt and Alicia Lammers to follow their care plan and then reapply in six months. And they say they will, but it still hurts that the VA said Matt hasn't improved in eight years.
M LAMMERS: All three of my limbs are still amputated, as they were June 10, 2007. Those have not grown back.
A LAMMERS: I still have to help him. I still have to drive him. I still have to take him to appointments.
M LAMMERS: And I wouldn't change anything for the world. I'm not complaining, and I don't get hung up on injuries.
A LAMMERS: I'm still going to do it, even if you pay me or not.
M LAMMERS: But what exactly do they expect from us triple amputees, single amputees, paras? I can't really comprehend that.
LAWRENCE: They agree Matt is doing better right now than he has in years. But the Lammers say that's not the point. At his best and at his worst, it shouldn't matter. They've earned it, and they need the help.
Quil Lawrence, NPR News, Tampa. Transcript provided by NPR, Copyright NPR.